Chest
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Coronary artery dissection is a rare entity which occurs following blunt chest trauma, during coronary angiography and coronary bypass surgery, and spontaneously in the peripartum period. We report a young man who presented with recurrent systemic emboli following an asymptomatic anterior wall myocardial infarction associated with dissection of the LAD and mural thrombus three years earlier after sustaining blunt chest trauma.
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The usual causes of hemomediastinum and hemothorax include chest trauma, rupture of an aortic aneurysm or aortic dissection. We report two patients who presented with a clinical picture of aortic dissection. ⋯ The tumors had undergone spontaneous bleeding into the mediastinum and the pleural space, presumably causing the patients pain. The interesting and unusual causes of spontaneous hemomediastinum and hemothorax are reviewed.
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To minimize work of breathing, airway pressure should not fluctuate during spontaneous breathing with continuous positive airway pressure (CPAP). However, flow resistance in the inspiratory limb of the breathing circuit and an inadequate continuous gas flow rate result in airway pressure fluctuation and increased work of breathing. ⋯ Work increased up to threefold with the balloon valve and more than tenfold with the flow resistor compared with the threshold resistor. To apply CPAP, expiratory pressure valves with low resistance to flow should be used to minimize fluctuations in airway pressure and, thus, in the work of spontaneous breathing.
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Comparative Study
Ventilation with the esophageal tracheal combitube in cardiopulmonary resuscitation. Promptness and effectiveness.
The success of cardiopulmonary resuscitation after cardiac arrest depends not only on the duration of the arrest, but also on the prompt establishment of a patent airway. In this study, we tested the safety and promptness of intubation with esophageal tracheal combitube (ETC) when compared to conventional endotracheal airway. Effectiveness of ventilation via the ETC as shown by blood gas analyses appeared to be comparable to endotracheal airway. Data suggest that the ETC might serve as a useful device during cardiopulmonary resuscitation.
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Computed tomography (CT) of the chest offers improved resolution and sensitivity for evaluating chest pathologic conditions compared with other imaging techniques. Intensive care unit patients with portable chest findings that diverge from the clinical course may actually have severe intrathoracic disease that can be detected with CT. Our three patients demonstrate chest CT can aid in the diagnosis of significant intrathoracic pathologic conditions which have been significantly underestimated by portable chest roentgenography. We discuss the reasons for this improved detectability by CT, as well as suggest alternative techniques that can be performed at the bedside in patients whose initial portable chest roentgenogram and clinical course do not correlate.