Canadian Medical Association journal
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It is desirable that every hospital of 100 beds or more should have an intensive care unit. An attempt is made to outline the more important features to be considered, including the physical aspects, when planning and establishing such a unit. The unit should contain 2-4% of the total number of hospital beds. ⋯ Orientation lectures and demonstrations must be carried out frequently and regularly. The types of patients to be admitted to the unit are discussed, as well as the governing rules and regulations. All doctors should have a right to admit and look after their own patients in the unit; an Intensive Care Unit Committee made up of representatives of the major services is suggested as a means of controlling admissions and discharges and for general administration.
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FOR PURPOSES OF CORRECT TREATMENT IT IS IMPORTANT TO RECOGNIZE THAT PATIENTS WITH COMPLETE ATRIOVENTRICULAR DISSOCIATION FALL INTO THREE GROUPS: Group I-established third-degree heart block with and without Stokes-Adams attacks; Group II-periodic third-degree heart block with and without Stokes-Adams attacks; Group III-established third-degree heart block with cardiac failure. Most patients in Group I present no technical problems when a pacemaker is implanted. In Group II it is advisable to insert a temporary intracardiac catheter electrode and maintain a rate of 60 to 64 during the periods of third-degree heart block. ⋯ Group III patients will often require a pacemaker set in excess of 74 beats until they are free of cardiac failure. Fifteen of 20 patients with complete atrioventricular dissociation showed marked functional improvement after insertion of a pacemaker. The development, in our laboratory, of a 4'' portable pacemaker impulse detector has been invaluable in locating the cause of failure in an implanted pacemaker.