Chest
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Bronchoscopy has been incorporated as a useful adjunct to increase the safety and effectiveness of percutaneous endoscopic tracheostomy (PET). Insertion of the bronchoscope, along with the intraluminal dilators of the PET set, into the airway potentially leads to hypoventilation and hypercarbia during the procedure. ⋯ In a third patient, the rise in PaCO2 was accompanied by a marked rise in intracranial pressure (ICP), and a corresponding fall in cerebral perfusion pressure. While transient hypercarbia seems well tolerated by most patients, this phenomenon and its effect on cerebral blood flow should be strongly considered before performing PET on the critically ill patient with evidence of elevated ICP.
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To characterize the physiologic response to, and safety of, intravenacaval membrane oxygenation and carbon dioxide removal. ⋯ Intravenacaval membrane oxygen and carbon dioxide removal can provide partial respiratory support during severe respiratory failure and permit reductions in the level of mechanical ventilator support, with an acceptable safety profile.
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To examine the hemodynamic and metabolic short-term effects of hypophosphatemia correction in patients with septic shock receiving catecholamine therapy. ⋯ Severe hypophosphatemia may be considered as a superimposed cause of myocardial depression, inadequate peripheral vasodilatation, and acidosis in septic shock. A rapid correction of hypophosphatemia is well tolerated and may have both myocardial and vascular beneficial effects. The magnitude of the response, however, is variable and unpredictable on the basis of serum phosphorus levels.
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Significant shallow-water injuries can occur in scuba divers, even in swimming pools. Two asthmatic patients are presented who sustained cerebral air emboli during Scuba classes in a swimming pool. Such injuries may be more common in asthmatics. Asthma is a contraindication to Scuba diving.
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To examine whether well-trained paramedics can perform emergent, successful, uncomplicated, endotracheal intubations during in-hospital cardiopulmonary resuscitation (CPR). ⋯ Paramedics can successfully, and without undue difficulty or complications, place endotracheal tubes during in-hospital CPR. Appropriately trained paramedics may be incorporated into hospital-based CPR teams in two contexts: (1) to provide an acceptable, long-term solution to the scarcity of personnel highly skilled in endotracheal tube placement during in-hospital CPR, and (2) to fulfill the need for hospitals to have on-site, qualified professionals to perform emergent endotracheal intubation during CPR. In the latter situation, personnel skilled in airway management could supplement the paramedics on demand. Further investigation in this area could be fruitful in view of the small sample size covered in this study.