Chest
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Carbon monoxide poisoning is a major cause of illness and death in the United States. Most cases result from exposure to the internal combustion engine and to stoves burning fossil fuels. Most cases of accidental exposure are preventable if proper precautions are taken; however, when cases arise, their presenting signs and symptoms are nonspecific and often lead to a misdiagnosis resembling a flu-like viral illness. ⋯ Treatment is directed toward the relief of tissue hypoxia and the removal of CO from the body. Severity of poisoning can be divided into three levels based on CO levels in the blood. Administration of normobaric 100 percent oxygen is the therapy of choice for most cases, while hyperbaric oxygen therapy is reserved for severe poisonings.
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Physicians often express concern about the reliability of critically ill patients' preferences regarding life-sustaining treatments. We interviewed 30 Veterans Administration intensive care unit patients to determine their preferences for resuscitation, resuscitation requiring mechanical ventilation, artificial hydration and nutrition, and hospitalization for treatment of pneumonia. Patients expressed their preferences considering their current health and then two hypothetical scenarios, stroke and dementia. ⋯ We found a diversity of opinions about life-sustaining treatments. Despite significant changes in health status and mood (p less than 0.05), treatment preferences were stable over time (kappa = .35-.70). Our results suggest that life-sustaining treatment preferences solicited during a serious illness are reliable and may be used in decision-making when a patient becomes unable to communicate or is mentally incapacitated.