Critical care medicine
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Critical care medicine · Feb 1985
Comparative StudyBag-valve-mask ventilation; two rescuers are better than one: preliminary report.
This study suggests that the bag-valve-mask (BVM) used by a single rescuer with minimal training fails to deliver adequate tidal volumes for resuscitation. When two rescuers use the BVM, tidal volumes are more than recommended and are comparable to those seen with endotracheal intubation. Two-person BVM ventilation should be considered for initial resuscitation in cardiopulmonary arrest.
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Each year, some 12,000 Americans are rendered paraplegic or quadriplegic by spinal cord injury. Most of these injuries result from motor vehicle accidents, falls, and sports-related trauma. ⋯ The following article has been prepared to help clinicians understand and manage patients with spinal cord injuries. It reviews the pathophysiology of spinal cord trauma, especially that involving the cervical region, and discusses the treatment of this condition from a critical care, rather than a neurosurgical, point of view.
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Critical care medicine · Feb 1985
Comparative StudyInduction and treatment of metabolic acidosis: a study of pH changes in porcine skeletal muscle and cerebrospinal fluid.
Metabolic acidosis was induced in 18 piglets of Swedish native breed by prolonged iv infusion of lactic acid, which decreased both blood and muscle pH. A two- to three-fold increase in muscle lactate content was related to the decrease in muscle pH. ⋯ The pH in muscle and cerebrospinal fluid (CSF) normalized only in the group treated with the tris buffer mixture. Thus, the tris buffer mixture was more effective than traditional sodium bicarbonate in correcting the acid-base disturbance in the CSF and the muscle intracellular compartment.
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Critical care medicine · Feb 1985
Effects of mechanical ventilation on cardiopulmonary function in children after open-heart surgery.
The reduction in functional residual capacity (FRC) after anesthesia and thoracic surgery may result in atelectasis, hypoxia, and respiratory failure. Mechanical ventilation reverses the FRC reduction but may also decrease cardiac output and increase the pulmonary vascular resistance index (PVRI) in some patients. The cardiopulmonary effects of stopping mechanical ventilation after open-heart surgery were studied in 17 children. ⋯ PVRI increased significantly in patients whose FRC fell below 22 ml/kg on spontaneous respiration. The PVRI increase was most marked in patients with pre-existing pulmonary vascular disease. These results confirm the value of appropriate mechanical ventilation in the early postoperative management of children undergoing open-heart surgery, particularly those with pulmonary vascular disease.