Critical care medicine
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Critical care medicine · Apr 1987
Case ReportsAtrial fibrillation with high degree atrioventricular block masquerading as ventricular fibrillation masquerading as asystole during cardiac arrest.
Ventricular fibrillation (VF) can masquerade as asystole. We report a 54-yr-old male in cardiac arrest who, on surface ECG, appeared to be in VF or asystole. ⋯ AF with a high degree block can masquerade as VF, which simultaneously masquerades as asystole, and can be correctly diagnosed by bedside intracardiac monitoring. Patients who have a flat line rhythm which may represent asystole, fine ventricular fibrillation, or atrial fibrillation with a high degree atrioventricular block may warrant a trial of electrical countershock, high-dose atropine, or transthoracic pacing.
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Tracheal wall movement can affect the lateral wall pressure and seal of an endotracheal cuff. This paper studies the relationship between proximal airway pressure (Paw) and the pressure in high-volume, low-pressure, tracheal tube cuffs. ⋯ Thus, adequate gas flow in the ventilator circuit cannot assure minimal pleural pressure changes. Decreases in cuff pressure may indicate inadequate CPAP and may explain why "just seal" pressure in endotracheal cuffs may not always prevent aspiration.
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Critical care medicine · Mar 1987
Clinical characteristics and resource utilization of ICU patients: implications for organization of intensive care.
We reviewed the clinical characteristics and resource utilization of 391 medical (M) and 315 surgical (S) ICU patients. In general, MICU patients had more physiologic derangement, as determined by the admission, maximal, and average acute physiology scores (APS). SICU patients had more frequent therapeutic interventions as measured by admission, maximal, and average therapeutic intervention scoring system values. ⋯ In contrast, 83% of patients with APS greater than 10 had considerable intensive interventions. These patients required mechanical ventilation, invasive monitoring, and vasoactive drugs more than twice as often as patients with lower APS scores. Consideration should be given, therefore, to the organization of ICUs according to the patient's severity of illness.