Critical care medicine
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Critical care medicine · Sep 1987
Impact of hemodynamic monitoring in a medical intensive care unit.
Previous reports have shown hemodynamic data inaccurately predicted by physical examination and x-ray findings. Although invasive hemodynamic monitoring has been shown to significantly alter the management of critically ill patients, the impact on mortality has been difficult to assess. ⋯ However, cardiac output was accurately estimated. Management was altered 34% of the time because of invasive hemodynamic assessment; however, mortality was not affected by a change in therapy.
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Airway obstruction remains a constant problem in acute care. This is particularly true when there are anatomical or pathological abnormalities, trauma, or when repeated failed attempts at endoscopic or blind intubations have left a bloody field, preventing clear visualization of the vocal cords. Our refinement of translaryngeal guided intubation (TLI) uses a spring guidewire accompanied by a plastic sheath protector. ⋯ A well-lubricated endotracheal tube is then inserted to the desired position using the plastic sheath as a stylet. This technique works very well, and we are convinced that TLI is one of the most effective emergency techniques to secure an airway. It can be performed quickly with inexpensive equipment and is a promising addition to the currently recommended alternatives.
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Critical care medicine · Sep 1987
Insertion of difficult nasogastric tubes through a nasoesophageally placed endotracheal tube.
A technique is described to facilitate the insertion of NG tubes with the aid of nasoesophageal insertion of an endotracheal tube. This technique is particularly useful in comatose and anesthetized patients. The equipment utilized is easily assembled and readily available. We have found this method to be easier and more successful than those previously described.