The American surgeon
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The American surgeon · Feb 1991
Hemodynamic effects of pressure support ventilation in cardiac surgery patients.
Hemodynamic consequences of pressure support ventilation (PSV) were compared with intermittent mandatory ventilation (IMV) in 20 patients following aortocoronary bypass. On the morning following surgery, all patients were weaned by IMV to a rate of eight breaths per minute, tidal volume of 12 ml/kg and inspired oxygen concentration of 40 per cent. With patients awake and able to breath spontaneously, PSV was begun at 20 cm of water. ⋯ PSV at levels of 20 and 10 cm H2O produced statistically significant increases in heart rate, mean arterial pressure, central venous pressure, and pulmonary capillary wedge pressure. Cardiac output was stable, and these increases were not clinically significant. In awake patients following cardiac surgery, PSV up to 30 cm H2O can be safely applied without hemodynamic embarrassment in patients with good left ventricular ejection fractions.
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The records of 138 patients admitted a Glasgow Coma Score (GCS) of 14 or 15 following head injury were reviewed to assess the need for hospital observation and to determine whether obtaining a normal computerized tomography (CT) scan in the emergency department could have avoided admission. GCS was 15 in 103 patients (74%) and 14 in 35 (26%). Eighty-three patients were admitted for their head injury alone, and 55 had other injuries but would have required admission for their head injury. ⋯ Significant CNS pathology does occur following "minimal" head injuries. Skull x rays are not helpful. The use of CT scanning appears to triage those patients requiring admission and in hospital observation.
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The American surgeon · Jan 1991
Randomized Controlled Trial Clinical TrialOutpatient cholecystectomy simulated in an inpatient population.
This prospective clinical trial evaluates the feasibility and safety of elective cholecystectomy in a simulated outpatient protocol in 40 patients. Results were compared with a 19-patient control group managed by conventional postoperative methods. Oral liquids were begun in the recovery room, intravenous fluids were discontinued 4 hours after surgery, and enteral analgesics and antiemetics were provided on the ward. ⋯ No major complications occurred. Outpatient cholecystectomy is both feasible and safe. Metoclopramide may allow earlier tolerance of enteral liquids postoperatively.
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Emergency center (ER) trauma evaluations often include leukocyte count (LC), serum amylase (SA), electrolytes (EL), and urine analysis. We reviewed records of 100 pediatric ER patients to determine utility of these tests in management of blunt injury. SA was evaluated in 65 patients and ranged from 30-146 U/L (mean 50.6 U/L); 14 patients with normal CT scans had SA from 30-68 U/L (mean 49.1 U/L). ⋯ DA predicted injury with sensitivity 60.0 per cent (specificity 79.2%). DA accurately represented LA results (sensitivity 100%, specificity of 94.5%). DA is a rapid and effective replacement of LA in evaluation of trauma patients in the emergency center.
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The American surgeon · Dec 1990
Left atrial to femoral arterial bypass using the biomedicus pump for operations of the thoracic aorta.
Left atrial to left femoral arterial bypass is an approach to operations of the thoracic aorta dating back to the late 1950s. Since that time, various modifications of the basic bypass circuit have evolved. ⋯ Recently, there have been reports of the use of the biomedicus centrifugal pump in bypass circuits of the thoracic aorta. Our series, as well as the success of others, using this variation of a traditional bypass circuit of the thoracic aorta, establishes the biopump's capability of minimizing inherent complications in the bypass circuit.