Canadian journal of surgery. Journal canadien de chirurgie
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To assess the impact on preoperative laboratory investigations in elective surgery after the implementation of guidelines for ordering such tests. ⋯ Implementation of guidelines for preoperative laboratory investigations for elective surgery resulted in a reduction in the number of tests without adverse impact on patient morbidity or mortality.
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Tension pneumothorax as a complication of ventilatory support may cause severe cardiac problems. The diagnosis may be difficult. Risk factors predisposing to the misdiagnosis of this condition include atypical location of the pneumothorax. ⋯ Placement of chest tubes into the localized pneumothoraces resulted in immediate improvement in hemodynamic status in two patients, but the third patient died before the chest tube could be placed. A diagnosis of tension pneumothorax should be considered in any patient on a ventilator whose hemodynamic status deteriorates in the presence of high airway pressures. In patients with adult respiratory distress syndrome the pneumothorax can remain localized because the heavy, noncompliant lungs cannot collapse enough for air to dissect diffusely through the pleural space; pleural adhesions may also contribute to this phenomenon.