Heart & lung : the journal of critical care
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Patients receiving intensive care frequently need pharmacologic support of their blood pressure because of shock. In some patients, shock is so severe that extremely high doses of vasopressors are needed to elevate their blood pressure. ⋯ In this study, little likelihood of intensive care unit survival was evident when patients received more than .5 μg/kg/minute of norepinephrine or epinephrine.
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To evaluate the diagnostic accuracy of 2 threshold values (105 breaths per minute [bpm]/L and 130 bpm/L) of the rapid shallow breathing index (RSBI) to predict a successful weaning trial outcome in a homogenous group of patients with chronic obstructive pulmonary disease (COPD). ⋯ RSBI measured early during an SBT cannot accurately predict the successful outcome of a T-piece trial in a homogenous population of patients with COPD.
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Review Case Reports
Left spontaneous pneumothorax presenting with ST-segment elevations: a case report and review of the literature.
Common electrocardiogram (ECG) changes associated with left-sided pneumothorax include right axis deviation, reduced R-wave amplitude in precordial leads, QRS alterations (amplitude changes), and T-wave inversions. Few reports exist of ST-segment elevations or changes suggestive of acute myocardial infarction (AMI), and these involve older patients with tension pneumothorax and previous coronary heart disease. ⋯ All changes resolved after decompression of the pneumothorax. On the basis of the patient's presenting symptoms, response to therapy, and our review of the literature, we propose a number of possible mechanisms explaining his electrocardiographic findings.
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We sought to describe the accuracy and precision of buccal pulse oximetry (SbpO(2)) compared with arterial oxygen saturation (SaO(2)) and pulse oximetry (SpO(2)) in healthy adults at normoxemia and under 3 induced hypoxemic conditions. ⋯ Buccal oximetry is an inaccurate and imprecise method of assessing SpO(2) when oxygen saturation is <90%. The divergence between SbpO(2) and both SaO(2) or SpO(2) values increased as hypoxemia worsened. The buccal method overestimated oxygen saturation in proportion to the degree of hypoxemia. Such overestimates may lead nurses to conclude falsely that a patient's arterial oxygen saturation is acceptable when further assessment or intervention is warranted.