Critical care medicine
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We undertook a prospective study of 125 intrahospital patient transports from the ICU in an attempt to identify any factors that could influence the occurrence of mishaps. One third of the transports sustained at least one mishap. Therapeutic intervention scoring system class IV transports had the highest rate of mishaps (35%). ⋯ Morbidity and mortality were not affected by mishaps. Although certain trends did emerge, no clearly defined predictive factor could be identified. Further study into transport mishaps is warranted.
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Critical care medicine · Mar 1990
Case ReportsSuccessful initiation of hemodialysis during cardiopulmonary resuscitation due to lethal hyperkalemia.
A 27-yr-old male uremic patient developed sudden cardiac arrest due to severe hyperkalemia. Despite 55 min of CPR and conventional treatment for hyperkalemia, cardiac arrest persisted. Hemodialysis was then performed during CPR and the patient recovered uneventfully. Hemodialysis should be considered in patients with cardiac arrest due to severe hyperkalemia if conventional therapies fail.
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Critical care medicine · Mar 1990
Low sensitivity of the anion gap as a screen to detect hyperlactatemia in critically ill patients.
The anion gap is commonly used as a screening test for the presence of lactic acidosis. Analysis of the distribution of anion gaps for 56 adult surgical ICU patients with peak blood lactate levels greater than or equal to 2.5 mmol/L showed the anion gap to be an insensitive screen for elevated lactate in a critically ill, hospitalized population. ⋯ Acidosis (pH less than 7.30) did not significantly alter mortality by lactate level. The observation that, for 57% of patients in this study, an elevated lactate level was not accompanied by an elevated anion gap suggests that hyperlactatemia should be included in the differential diagnosis of nonanion gap acidosis.