Arch Intern Med
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Fifty-four elderly patients with thermoregulatory failure were evaluated retrospectively. The most commonly associated cause was underlying sepsis, which occurred in 78% of cases. Underlying conditions that increased the incidence of hypothermia were hypoproteinemia (50%), cachexia (30%), and neuroleptic medications (21%), most commonly thioridazine. ⋯ The mortality rate was not affected by age, sex, or degree of hypothermia. We conclude that thermo-regulatory failure in the elderly can occur in warm as well as cold environments or climates. The development of hypothermia in elderly patients should be promptly treated as sepsis unless proven otherwise, in light of the poor prognosis of this condition.
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Clinical and demographic characteristics of 122 patients undergoing cardiopulmonary resuscitation were retrospectively collected to develop a predictive model for immediate success of resuscitation (restoration of pulse and blood pressure). The project focused on objective measurement of parameters available before resuscitation was performed. ⋯ The four predictive before arrest factors were age between 40 and 70 years, scheduled for surgery, location of arrest in an intensive care unit, and before arrest PO2 greater than 8 mm Hg. The model had an accuracy of 69%, sensitivity of 76%, and specificity of 61%.
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The hyperviscosity syndrome is most commonly seen in association with monoclonal gammopathies and has only rarely been described in association with polyclonal hypergammaglobulinemia. We have recently seen a patient with known acquired immunodeficiency syndrome who presented with the hyperviscosity syndrome in the setting of polyclonal hypergammaglobulinemia. To our knowledge, this is the first reported case of a patient with the acquired immunodeficiency syndrome and the hyperviscosity syndrome. The case is presented and the pathogenesis and implications of this diagnosis are discussed.
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To evaluate a new multilumen central venous catheter we prospectively compared the infection rates of 63 single-lumen and 157 triple-lumen catheters in 145 critically ill patients. Using acute physiology scores, severity of illness was shown to be similar in the two patient groups. There were no significant differences in the rate of catheter colonization or catheter-related sepsis comparing single-lumen with triple-lumen catheters. ⋯ The only factor that was clearly associated with catheter sepsis was the duration of catheterization. Catheter sepsis increased from 1.5% to 10% when the period of catheterization exceeded 6 days. We conclude that the use of triple- and single-lumen central venous catheters in critically ill patients entails similar risks of infection.
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To address moral questions in patient care, hospitals and health care systems have enlisted the help of hospital ethicists, ethics committees, and ethics consultation services. Most physicians have not been trained in the concepts, skills, or language of clinical ethics, and few ethicists have been trained in clinical medicine, so neither group can fully identify, analyze, and resolve clinical ethical problems. ⋯ If they are to be effective consultants, however, nonphysician-ethicists need to be "clinicians": professionals who understand an individual patient's medical condition and personal situation well enough to help in managing the case. Ethics consultants and ethics committees may work together, but they have separate identities and distinct objectives: ethics consultants are responsible for patient care, while ethics committees are administrative bodies whose primary task is to advise in creating institutional policy.