Medicina
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Hypothermia is defined as a core body temperature less than 35 degrees C (95 degrees F) and results from prolonged exposure to cold environment, drugs, and underlying pathologic conditions. Hypothermia is associated with marked depression of cerebral blood flow and oxygen requirement, reduced cardiac output, and decreased arterial pressure. Victims can appear to be clinically dead because of marked depression of brain and cardiovascular function, bet full resuscitation with intact neurological recovery is possible. ⋯ There are suggestions that the unofficial number of hypothermia--related deaths is substantially higher, particularity in the elderly. This article reviews the cause, pathogenesis, pathophysiology, clinical features, electrocardiographic manifestations of hypothermia, diagnosis, pre-hospital stabilization, hospital passive, active external, active core rewarming methods, other questions of treatment, and mortality of hypothermia. It is very important to remember, thar if a hypothermic victim is alive when rescued but dies during recovery treatment, and there is no other significant trauma or disease, this suggests that death may have resulted from either inappropriate or ineffective treatment, or no treatment at all.
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The article deals with the problems of perioperative management of patient with respiratory disease. The impact of general and regional anesthesia on respiratory system is discussed. Risk factors of perioperative respiratory complications are reviewed as well as general means for reducing them. Issues of anesthetic management of patients with bronchial asthma and chronic respiratory disease are discussed, putting stress on preoperative optimization of respiratory function, choice of anesthetic technique and postoperative pulmonary rehabilitation.
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The aim of the article is to review principles of thoracic anesthesia for pulmonary surgery. This article is divided into three sections. ⋯ Intraoperative period considerations are monitoring requirements, choice of anaesthesia and the indications for providing one-lung ventilation. Postoperative problems of immediate life-threatening complications, management of mechanical ventilation and control of pain are discussed in the third part.
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Review Case Reports
[The importance of left bundle branch block in the diagnosis of acute myocardial infarction].
Electrocardiographic (ECG) evidence of cardiac ischemia or infarction is difficult to detect in the presence of left bundle branch block (LBBB). Traditional ECG indicators of ischemia, such as ST- segment elevation, are common in LBBB and may not indicate acute ischemia. Proper evaluation of the initial ECG is crucial in selecting candidates for early thrombolysis, because the earlier reperfusion treatment is administred, the better are the results. ⋯ In the absence of definitive diagnosis of AMI doctors withhold from decision to administer thrombolytic treatment because of risk of haemorrhagic complications. There are not perfect diagnostic tools allowing early diagnostic of AMI in patients having LBBB. Currently the best justified strategy is to follow AHA/ACC recommended guidelines to administer thrombolysis to all patients with LBBB presenting with chest pain, particularly if serum biomarkers are elevated.
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Venous air embolism is the entry of air into the venous system as a consequence of trauma or iatrogenic complications (especially central venous cannulation or pressurized intravenous infusion systems). It also can occur following the surgical procedures. Venous air embolism results in right ventricular dysfunction and pulmonary injury. In this review article various causes, frequency, pathophysiology, clinical features, diagnosis, treatment, outcome and prevention of venous air embolism are discussed.