JAMA : the journal of the American Medical Association
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The cases of four patients included sufficient circumstantial evidence to suspect carbon monoxide poisoning as the principal etiologic agent, although the diagnosis was unconfirmed. In two other patients, CO poisoning was proven by elevated carboxyhemoglobin levels. All six patients were transferred from outlying hospitals for failure to respond adequately to standard therapy and recovered completely following treatment with hyperbaric oxygen. Hyperbaric oxygen should be used for severe cases of suspected CO poisoning, regardless of the time between exposure and presentation, especially when the delay is sufficient to preclude a diagnosis by standard laboratory methods.
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All admissions (2,693) to a medical intensive and coronary care unit (ICU/CCU) during a two-year period were reviewed to compare indications for admission, major interventions, and outcomes for elderly patients with those for younger patients. Once admitted to the ICU/CCU, older patients were more likely to receive major life-support interventions such as mechanical ventilation but less likely to survive. Major interventions were used in 32% of patients aged 75 years or older, in 26% of those 65 to 74 years, and in 22% of those 55 to 64 years. ⋯ Hospital mortality for the oldest patients was 16%, compared with 14% and 8% for the younger age groups. Cumulative mortality one year after discharge for those older than 75 years was 44%. Elderly hospital survivors returned to their preadmission living situation but did not regain their preadmission activity level.