Chest
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In patients with blunt chest trauma, early diagnosis of mediastinal hematoma is important, because it could be associated with thoracic vessel injury. Mediastinal hematoma is generally evoked because of a widened mediastinum on chest radiograph, but radiologic diagnosis may lead to excessive angiography being performed. Transesophageal echocardiography (TEE) provides accurate views of the mediastinum and can be rapidly performed at the bedside. ⋯ We described three different TEE signs of mediastinal hematoma: (1) an increased distance between the probe and the aortic wall; (2) a double contour of the aortic wall; and (3) visualization of the ultrasound signal between the aortic wall and the visceral pleura. The distance between the esophageal probe and the aortic wall was the most accurate sign because it could be easily obtained; the threshold value for this distance was 3 mm. TEE appears to be an accurate method to diagnose traumatic mediastinal hematoma.
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Case Reports
Endotracheal tube and tracheobronchial obstruction as causes of hypoventilation with high inspiratory pressures.
Two cases of difficult ventilation are presented, the first caused by endotracheal tube obstruction with nasal turbinate, and the second caused by tracheobronchial obstruction with blood clots. The clinical presentation in each case was characterized by extreme difficulty in ventilating and severe hypercapnia despite vigorous ventilatory efforts with either a mechanical ventilator or resuscitator bag. A simple manipulation of the endotracheal tube cuff helped to differentiate between increased impedance caused by endotracheal tube obstruction as opposed to increased respiratory system impedance beyond the tip of tube. In the second patient, in whom even a short interruption of ventilation was poorly tolerated, simultaneous rigid bronchoscopy (for removal of intratracheal masses) and ventilation via endotracheal tube were successfully performed.
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To evaluate an equation that estimates resting energy expenditure from two easily obtained measurements--expired carbon dioxide and minute ventilation, and compare the results of this equation with standard methods of estimating and measuring caloric expenditure in mechanically ventilated patients. ⋯ Minute ventilation and expired carbon dioxide measurements are easily and inexpensively obtainable. Energy expenditures calculated from these measurements (CEE) compare favorably with values obtained from a metabolic cart and are significantly more accurate than HBc.
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A unique association of giant lymph node hyperplasia (Castleman's disease) and cardiac tamponade is presented. Although pleural effusions have been previously described with Castleman's disease, the authors believe this to be the first report of pericardial effusion and tamponade with this entity. The development of effusions may be due to an inflammatory syndrome sometimes seen with the plasma cell variant of this disease.