Intensive care medicine
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Intensive care medicine · May 1979
Autonomic dysfunction in tetanus: the effects of a variety of therapeutic agents, with special refernce to morphine.
Sympathetic overactivity in tetanus is a common event and may be difficult to control. This report demonstrates the efficacy of morphine in this clinical situation and also discusses the sympathetic effects of 3 muscle relaxants, pancuronium, d-tubocurarine and alcuronium.
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Intensive care medicine · May 1979
Case ReportsTension pneumoperitoneum complicating cardiac resuscitation.
A case of gastric rupture and tension pneumonperitoneum following cardiac resuscitation is presented. Respiratory embarrassment necessitated emergency decompression by needle puncture of the peritoneal cavity, followed by laparotomy and repair of the gastric tear. The post-operative course has been satisfactory. The aetiology of the gastric rupture is discussed and recommendations are made for the prevention and treatment of this unusual complication of combined mouth to mouth respiration and external cardiac massage.
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Intensive care medicine · Nov 1978
Case ReportsA rationale for epidural analgesia in the treatment of multiple rib fractures.
Thoracic epidural analgesia (EA) is described as an alternative to controlled ventilation in patients presenting with multiple rib fractures. Lung mechanics were especially studied in 6 patients selected from a total of 49. The average ICU stay for this group was 4.5 days (2-11) and the mean age 55.7 years. ⋯ Severe pulmonary and cerebral contusion were the two most important factors in enforcing the need to ventilate. The success of the method is evidenced by the increase in functional residual capacity (FRC), dynamic lung compliance (Cdyn), vital capacity (VC), the decrease of airway resistance (R) and a significantly increase of PaO2 (p less than 0,001) for the EA group with a balanced fluid therapy. All this accounts for the clinical observation of diminishing paradoxical movement of the flail segment.
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Intensive care medicine · Nov 1978
Case ReportsAcute miliary tuberculosis presenting as acute respiratory failure.
A 42 year old pregnant woman was admitted in acute respiratory failure. Viral pneumonia was suspected and oxygen therapy, CPAP, water restriction and diuretics were started with good response. She remained febrile and had an abnormal chest X-ray, a diagnosis of miliary tuberculosis was confirmed by transbronchial fibreoptic lung biopsy.