Resp Care
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Case Reports
Mediastinal teratoma with pulmonary involvement presenting as massive hemoptysis in 2 patients.
Massive hemoptysis is described in many disease processes. However, a mediastinal teratoma is rarely considered in a patient presenting with massive hemoptysis. ⋯ Flexible bronchoscopy can be diagnostic in cases of a mediastinal teratoma with involvement of the bronchial tree. We report 2 cases of hemoptysis caused by mediastinal teratoma with bronchial communication.
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To determine the impact of the 2005 American Heart Association cardiopulmonary resuscitation (CPR) guidelines, including use of an impedance threshold device (ITD), on survival after in-hospital cardiac arrest. ⋯ Implementation of improved ways to increase circulation during CPR increased the in-hospital discharge rate by 60%, compared to historical controls in 2 community hospitals. These data demonstrate that immediate care with improved means to circulate blood during CPR significantly reduces hospital mortality from inhospital sudden cardiac arrest.
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Tracheostomy tubes are placed for a variety of reasons, including failure to wean from mechanical ventilation, inability to protect the airway due to impaired mental status, inability to manage excessive secretions, and upper-airway obstruction. A tracheostomy tube is required in approximately 10% of patients receiving mechanical ventilation and allows the patient to move to a step-down unit or long-term care hospital. The presence of a tracheostomy tube in the trachea can cause complications, including tracheal stenosis, bleeding, infection, aspiration pneumonia, and fistula formation from the trachea to either the esophagus or the innominate artery. Final removal of the tracheostomy tube is an important step in the recovery from chronic critical illness and can usually be done once the indication for the tube placement has resolved.
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Knowing when to change a tracheostomy tube is important for optimal management of all patients with tracheostomy tubes. The first tracheostomy tube change, performed 1-2 weeks after placement, carries some risk and should be performed by a skilled operator in a safe environment. The risk associated with changing the tracheostomy tube then usually diminishes over time as the tracheo-cutaneous tract matures. ⋯ Some of the specialized tracheostomy tubes available on the market are discussed. There are few data available to guide the timing of routine tracheostomy tube changes. Some guidelines are suggested.