Chest
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We report an uncommon and potentially dangerous complication of continuous positive airway pressure (CPAP) applied during spontaneous respiration. A patient with multiple fractures and recurrernt atelectasis developed pneumocephalus on the seventh day of respiratory therapy with CPAP via a face mask. A fracture of the base of the skull, not recognized despite neurologic and radiologic evaluation at admission, was at the origin of this complication.
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A 68-year-old patient developed increasingly frequent episodes of ventricular and supraventricular arrhythmias over the past five years. During the last 12 months, he was admitted to the hospital on several occasions with complex arrhythmias including multifocal PVCs, bigeminy, trigeminy, ventricular tachycardia, and atrial flutter and fibrillation. Large and frequent doses of quinidine, procainamide, disopyramide, propranolol, and digoxin failed to suppress his arrhythmias. ⋯ A new antiarrhythmic drug, lorcainide, was given intravenously and it suppressed all PVCs, including bigeminy and ventricular tachycardia. All his arrhythmias have been completely suppressed by oral regimens of lorcainide, 100 mg four times daily, for the past four months. This is the first case of oral treatment of ventricular arrhythmias with lorcainide in this country.
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In a study of 12 critically ill patients, values for mixed venous oxygen saturation (SVO2) were measured from samples of pulmonary arterial blood drawn at five rates of withdrawal (1, 3, 10, 20, and 30 ml/min). Samples were drawn from properly placed pulmonary arterial catheters with the balloon deflated. ⋯ Evaluations by paired t-test comparing all rates of withdrawal with the slowest rate (1 ml/min) showed no significant differences. The rate of withdrawal of the sample is not associated with significant errors in SVO2 when samples are drawn from a properly positioned pulmonary arterial catheter.
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One hundred eighty-three patients had simultaneous blood and pleural fluid pH determinations. Thirty-six effusions were transudates, and 147 were exudates. ⋯ The results of pleural fluid pH determination are immediately available, narrow the differential diagnosis of the exudate, and may expedite patient management. The pH of pleural fluid should be measured whenever a diagnostic thoracocentesis is performed.