Crit Care Resusc
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To review the pharmacodynamic and pharmacokinetic properties of digoxin in health and disease and the potential use and toxic effects of digoxin in the critically ill patient. ⋯ Digoxin is a therapeutic agent with unique effects. It should be considered in all patients with systolic heart failure, supraventricular tachycardia, and, in association with other treatment, as a single dose of 750 -1000 mug/70 kg in patients not treated previously with digoxin who have septic shock. It should be avoided in patients with critical coronary artery disease and ischaemic or hypertrophic diastolic failure.
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To review the current status of echocardiography in critically ill patients with special reference to the advantages and disadvantages of the transthoracic and transoesophageal approaches. ⋯ Echocardiography is a rapidly developing technology. Cardiac structures can be imaged in 'real time'. Image quality continues to improve. The use of transoesophageal probe positioning has also widened the potential of this bedside technique in critically ill patients.
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Dissection of the internal carotid artery is often caused by trauma to the face or neck. It usually has a delayed onset neurological presentation, a partial middle cerebral artery territory syndrome, 'normal' early CT scan, MRI evidence of middle cerebral artery occlusion, progressive partial or complete neurological recovery, and duplex scan evidence of a reestablished lumen in the internal carotid artery after 10 weeks. A case is reported of a dissection of the right internal carotid artery in a patient with severe facial trauma. ⋯ The patient was anticoagulated and over the next two weeks made a slow recovery, using her left hand effectively and walking unaided. Four months after the accident a duplex scan revealed that the right carotid artery lumen was patent with normal arterial flows. Five months after the accident the patient had returned to work.