Annals of emergency medicine
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To assess the effect of a 33% coronary stenosis on myocardial blood flow during normal sinus rhythm and CPR. ⋯ Minimal coronary lesions that do not diminish myocardial perfusion during normal physiologic conditions appear to significantly decrease subendocardial blood flow during cardiac arrest and CPR.
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Comparative Study
Use of hypertonic saline/dextran versus lactated Ringer's solution as a resuscitation fluid after uncontrolled aortic hemorrhage in anesthetized swine.
We tested the hypothesis that following aortotomy, administration of hypertonic saline/dextran increases hemorrhage and mortality. We also compared hypertonic saline/dextran with the standard therapy of attempting to replace three times the amount of lost blood with lactated Ringer's solution. ⋯ In this model of uncontrolled hemorrhage, immediate IV administration of hypertonic saline/dextran significantly increased hemorrhage volume and mortality. However, the accentuation of hemorrhage and reduction in survival were not as great as that produced by the standard practice of attempting to replace the lost blood with three times that volume of lactated Ringer's.
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Heart and heart/lung transplants are accepted forms of therapy for patients with end-stage cardiac or pulmonary disease. These patients are likely to present postoperatively to the emergency department. To our knowledge, there have been no previous reports in the medical literature of the ED presentation of these patients. ⋯ The transplant patient, by virtue of requiring chronic immunosuppression, is susceptible to infection with a spectrum of opportunistic organisms. When fever or other symptoms suggest infection, appropriate cultures and aggressive diagnostic procedures (eg, lumbar puncture, bronchoscopy) should be performed.