Crit Care Resusc
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Biography Historical Article
19th century pioneers of intensive therapy in North America. Part 2: Joseph O'Dwyer.
Dr Joseph O'Dwyer's principal distinction lies in his dedication and achievements in battling laryngeal diphtheria among children at the New York Foundling Asylum, where he was a physician from 1872. He was also active at the Presbyterian Hospital of New York and in private practice. ⋯ The first intubated patient recovered, November 1882, only after change to prolonged wearing of a tracheotomy tube, so O'Dwyer did not date his first intubation success until 21 May 1884. * Introduction of his tubes into the Fell method of forced respiration, with the resultant Fell-O'Dwyer apparatus supplying practical instrumentation for intermittent positive pressure ventilation. * Demonstration that this apparatus, primarily used for saving lives after acute opiate poisoning, was also useful with some intracranial disasters, 1894. * Provision of a system, which others then applied, enabling surgeons to overcome the great "pneumothorax problem" of intrathoracic operations, and thereby conduct safe surgery inside the chest, 1898. * Development of an intubating method using successive short-term dilatations for treating chronic laryngeal stenosis, usually syphilitic, in adults, 1885. Throughout his medical lifetime, O'Dwyer was held in the highest regard as an altruistic, compassionate person of "sincere simplicity and frank goodness of character".
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Comparative Study
Missed opportunities? An observational study of vital sign measurements.
To determine the frequency of monitoring of patient vital signs in two wards of a tertiary hospital. ⋯ Blood pressure, heart rate and temperature were the most diligently recorded vital signs, but documentation of respiratory rate was poor. Failure to perform vital sign measurements may underpin the failure to recognise patients in general wards whose condition is deteriorating.
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To review the indications for admission, demographics, clinically relevant aspects of medical care and outcomes of critically ill obstetric patients admitted to a tertiary hospital intensive care unit. ⋯ This audit is a reminder that continued vigilance is required to ensure maternal safety. It also emphasises the need to integrate free-standing maternity units with hospital intensive care services.
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Severe septicaemia secondary to melioidosis carries a high mortality. Although melioidosis can involve most tissues and organs, pericardial involvement is rare. ⋯ This is the first case in Australia or New Zealand of melioid sepsis presenting with pericarditis and subsequent cardiac tamponade. We review the literature on cardiac involvement in melioidosis.