Critical care medicine
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Critical care medicine · Feb 1990
Comparative StudyEpidural analgesia in thoracic trauma: effects of lumbar morphine and thoracic bupivacaine on pulmonary function.
Changes in pulmonary function tests were compared in 14 thoracic trauma patients, of whom seven received thoracic epidural bupivacaine for analgesia and seven received lumbar epidural morphine. In both groups epidural analgesia decreased subjective pain levels when compared to parenteral narcotics which the patients received before epidural catheter placement. ⋯ Patients in the morphine group had no significant change in pulmonary function. The use of thoracic epidural bupivacaine for analgesia in post-traumatic chest injuries produced superior improvement in pulmonary function when compared to lumbar epidural morphine.
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In the development of triage and bypass protocols, many different scoring systems and triage criteria are being used. Our purpose was to evaluate the Revised Trauma Index (RTI) as a triage tool for both its severity prediction ability and triage accuracy. A total of 2,340 trauma admissions were evaluated using the RTI and the Injury Severity Score (ISS). ⋯ There is 5% death rate at an RTI level of 15, which yields a 5% undertriage rate for death and a 37.3% overtriage rate for predicting an ISS greater than 15. This compares to under and overtriage rates for the Trauma Score, CRAMS, Pre-Hospital Index, and Mechanism of Injury scales varying from 19% to 56% undertriage and 7% to 82% overtriage. We reached the following conclusions. a) The RTI is a simple, fast triage tool for predicting major trauma. b) The RTI is related to the ultimate ISS. c) Use of an RTI greater than or equal to 15 results in an acceptable undertriage rate, with a better rate for overtriage than existing scores. d) Therefore, we recommend the RTI for use in emergency medical direction and bypass protocols.
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Critical care medicine · Feb 1990
Review Comparative StudySensitivity and specificity of blood cultures obtained through intravascular catheters.
The reliability of blood cultures obtained through indwelling intravascular catheters is controversial. In this study, the results of 200 catheter blood cultures were compared with those of an equal number of peripheral blood cultures drawn at the same time. Catheter blood cultures were found to be 96% sensitive (95% confidence interval, 89% to 100%) and 98% specific (95% confidence interval, 96% to 100%) for the detection of septicemia. Factors thought to have influenced these favorable results were the relatively short duration of catheter placement and the particular emphasis given to aseptic technique.
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During the course of a critical illness, many patients become ventilator dependent. The standard assessment criteria are not always accurate in predicting potential for extubation. This investigation was designed to analyze whether the work of breathing (WOB) was a more reliable predictor of ventilator dependence. ⋯ These data support the use of WOB determinations in evaluating extubation potential. Using a reference value for the WOB of 15%, this study had a sensitivity of 100% and a specificity of 80%. This proved to be of greater predictive value than traditional criteria.
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Critical care medicine · Feb 1990
Case ReportsLow-frequency positive-pressure ventilation with extracorporeal carbon dioxide removal.
Successful use of a new technique, low-frequency positive-pressure ventilation with extracorporeal CO2 removal (LFPPV-ECCR) is presented. The association of fulminant respiratory failure with CNS hemangioblastoma, described in the present patient, has been reported only once before, in 1928.