Respiratory care clinics of North America
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Respiratory considerations in aeromedically evacuated patients are the cornerstone of safe, successful transport. Maintenance of the ABCs and ongoing resuscitation including pulmonary/ventilator stabilization and management en route are paramount. All of these goals are predicated on a well-developed understanding of hypobaric pulmonary physiology and hypobaric effects on medical devices, a solid grasp of the inherent limits of an aeromedical environment, and the resolute accomplishment of both initial and follow-up team member training.
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Combined flail chest and pulmonary contusion is a frequent problem in patients with blunt multisystem trauma admitted to the intensive care unit. These patients are at high risk for pneumonia and adult respiratory distress syndrome, which adds substantially to their morbidity and mortality rates. This article discusses the epidemiology and pathophysiology of this condition and the role of the respiratory care practitioner in the optimal management of these critically injured patients.
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Ventilatory support during cardiopulmonary resuscitation can be accomplished with an array of methods and devices. These run the gamut from expired air resuscitation, including mouth-to-mouth and mouth-to-mask, to the use of ventilators including ventilator-to-mask and ventilator-to-artificial airway techniques. Appropriate application of these techniques depends on the clinical situation, rescuer training, and availability of equipment. This article discusses the proposed standards of emergency ventilatory support, the advantages and disadvantages of the techniques and devices used, and current controversies surrounding this topic.
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The development of regional techniques of analgesia has revolutionized the management of blunt thoracic trauma. The standard of care has evolved from intubation and mechanical ventilation for all patients to optimization of pain control combined with chest physiotherapy. ⋯ It still remains for improvement in outcome to be demonstrated when epidural analgesia is used, but it is clear that subjective patient comfort is increased and that pulmonary parameters can be improved. In appropriately selected patients, those without head injury or who have been adequately evaluated for intra-abdominal injury, epidural analgesia is currently the preferred method for pain control following severe thoracic trauma.