Heart & lung : the journal of critical care
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Case Reports
Digoxin toxicity presenting as altered mental status in a patient with severe chronic obstructive lung disease.
Gastrointestinal and cardiac manifestations are the commonly considered features of digoxin toxicity. This report describes a patient with severe chronic obstructive lung disease whose primary manifestation of digoxin toxicity is acute alteration of mental status. Neurologic dysfunction may be the sole manifestation of digitalis toxicity. The diagnosis of digoxin toxicity should be considered in elderly patients with altered mental status, even when serum levels are within a therapeutic range.
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Recent evidence indicates that misdiagnosis of cardiac arrhythmias is a common occurrence in critical care and telemetry units. The present article addresses the problem by reviewing electrocardiographic criteria for diagnosing the arrhythmias and ischemic conditions of major importance in the critically ill patient including wide QRS complex tachycardias, bundle branch blocks, and ST segment monitoring after thrombolytic therapy and balloon angioplasty. In addition, the advantages and disadvantages of various monitoring leads are discussed with recommendations regarding the most ideal leads for detecting these arrhythmias of interest. Finally, practical suggestions are offered for improving the quality of bedside electrocardiographic monitoring.
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This article is a review and analysis of published and unpublished research on the efficacy of both dilute heparin solutions and normal saline solutions in flushing and maintaining the patency of vascular catheters. Twenty studies involving both intravenous and intraarterial catheters in pediatric and adult patients are summarized and analyzed both quantitatively and qualitatively. Thirteen studies that were conceptually similar were subjected to a meta-analysis; no significant difference in duration of patency was found between intravascular catheters flushed with saline solution and those flushed with a heparinized solution. Implications for changing practice based on research findings are discussed.
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Randomized Controlled Trial Clinical Trial
Endotracheal suctioning in adults with head injury.
The purpose of this study was to determine the method of endotracheal suctioning (ETS) that resulted in the least compromise to the cerebrovascular status of adult patients with severe head injuries. A two-group (two vs three ETS), two-protocol (100% tidal volume [VT] vs 135% VT) design was used. The dependent variables were mean intracranial pressure (MICP), mean arterial pressure (MAP), cerebral perfusion pressure (CPP), heart rate (HR), and oxygen saturation (SaO2). ⋯ No significant difference was found for SaO2 for either of the protocols regardless of number of suction passes. No significant differences were found between two- and three-ETS groups for any of the dependent variables. All groups, however, regardless of number of suction passes, demonstrated a cumulative increase in MICP, MAP, and CPP with each consecutive suction sequence.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Clinical Trial
Effect of lung hyperinflation and endotracheal suctioning on heart rate and rhythm in patients after coronary artery bypass graft surgery.
We examined the effect of lung hyperinflation and suction on PaO2, heart rate, and rhythm in patients after coronary artery bypass graft surgery (N = 26). Three lung hyperinflation breaths, at one of five randomly ordered volumes (tidal volume, 12 cc/kg, 14 cc/kg, 16 cc/kg, or 18 cc/kg of lean body weight) were delivered, by a ventilator (fraction of inspired oxygen 1.0), followed by 10 seconds of continuous suction. Lung hyperinflation and suctioning were repeated three times. ⋯ The majority of rhythm changes for lung hyperinflation and suctioning were from normal sinus rhythm to sinus tachycardia. Suction was associated with a greater incidence of rhythm (53.9%) and arrhythmia (80.8%) changes. The most frequent arrhythmia was premature atrial contraction.