Heart & lung : the journal of critical care
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Patients undergoing cardiac surgery are mildly hypothermic by the completion of the surgical procedure. They need to return to a normothermic state if enzymatic functions are to proceed in their normal manner. The body can produce heat by elevating metabolic rate or by activating the shivering mechanism. ⋯ External methods, which minimize additional heat loss, include the use of warming lights, elevation of room temperature, and the use of blankets. Internal methods, which transfer heat by convection, may be used to help actively reverse hypothermia. Such techniques include warmed inhalation gases and intravenous fluids, warmed nasogastric lavage fluid, and warmed peritoneal dialysis fluid for patients with end-stage renal failure with severe electrolyte disorders after surgery.
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Clinical Trial Controlled Clinical Trial
Patient-controlled analgesia versus intermittent analgesia dosing.
Actively involving the patient in his or her own pain management by using patient-controlled analgesia (PCA) during the postoperative period is a concept recently introduced. This method allows self-administration of small, frequent doses of an analgesic agent to maintain a state of constant pain control. We studied the relative efficacy of PCA compared with intermittent analgesic dosing in 16 male patients requiring posterolateral thoracotomy. ⋯ In the patients using PCA, a significant reduction in the postoperative pulmonary complication rate, as evidenced by radiographic findings, was noted. In addition, significantly less medication was used and postoperative fever was substantially reduced in the PCA group. We believe PCA to be a safe, effective, and beneficial pain management modality that deserves attention in the postoperative period.
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Our purpose in this study was to investigate the factors coincident with the occurrence of dyspnea in ventilator-assisted patients. Five alert and oriented patients with pulmonary disease that was restrictive, obstructive, or both, who were receiving mechanical ventilation, participated in this descriptive study. ⋯ A moderate correlation (r = 0.51, p less than 0.001) was found between the number of events and activities occurring in the intensive care unit environment and the occurrence and severity of dyspnea. The visual analogue scale and modified Borg scale measures of dyspnea were highly correlated (r = 0.92, p less than 0.001) and may be useful tools for assessing dyspnea in patients undergoing mechanical ventilation.
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Review Case Reports
Iliac vein to pulmonary artery missile embolus: case report and review of the literature.
Intravascular foreign body emboli, although first reported in 1834, are rare sequelae of penetrating injuries. We report a case of missile embolus to the pulmonary artery after penetrating injury to the left iliac vein and artery. A review of the literature and discussion of appropriate management are presented.
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In a prospective study, the intensity of extrapyramidal symptoms (EPS) was rated in two groups of delirious, medically ill patients. Fourteen patients received intravenous (IV) haloperidol and benzodiazepines for control of severe agitation and four received IV haloperidol alone. Patients were rated daily by a standardized scale for EPS by raters blind to the dose of haloperidol and benzodiazepines. ⋯ In the haloperidol and benzodiazepine group there were only one case of very mild parkinsonian-like EPS and no cases of akathisia or dystonia. No adverse respiratory or cardiac reactions were seen in any patients. The literature on the use of IV haloperidol alone and in combination with benzodiazepines is briefly reviewed and possible explanations of the lower intensity of EPS with IV haloperidol in combination with benzodiazepines are discussed.