The Journal of the Oklahoma State Medical Association
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J Okla State Med Assoc · Aug 1994
Comparative StudyUnderstanding mechanical ventilation: indications for and initiation of therapy.
The growing complexity of mechanical ventilators and the proliferation of new ventilator modes may confuse and intimidate clinicians who on occasion must manage a mechanical ventilator. The fundamental indications for and types of mechanical ventilation are reviewed, and guidelines for basic ventilator settings are provided. By understanding and applying these essentials, the clinician can provide effective mechanical ventilation to most patients who require it. A subsequent article published in this journal will review the related topics of patient monitoring during mechanical ventilation, complications of mechanical ventilation, and weaning from mechanical ventilation.
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J Okla State Med Assoc · Apr 1994
Case ReportsGunshot wounds traversing the mediastinum: guidelines for evaluation and management.
When there is suspicion that a penetrating would to the chest has crossed the midline, it is incumbent upon the medical staff to actively exclude injuries to mediastinal structures such as the heart, aortic arch, bronchial tree, and esophagus, even though injury to such structures may not be immediately clinically apparent. The successful management of a patient with a gunshot wound apparently traversing the anterior mediastinum is presented; an esophagram identified an unsuspected through-and-through injury to the esophagus. The evaluation of this patient is discussed, and an algorithm for the evaluation and management of similar patients is proposed.
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To determine the extent of firearms as a cause of mortality, Oklahoma vital statistic records were analyzed. The annual mortality rate in Oklahoma between 1985 and 1989 was 20% higher than the U. S. rate. ⋯ Suicide rates were highest among white males 65 years and older; homicide rates peaked among black males 25 to 34 years of age. Residents of eastern Oklahoma had the highest rates. The magnitude and preventability of firearm-related deaths and injuries demand attention and collaboration from Oklahoma health care providers; public health, mental health, and education officials; and criminal justice professionals.
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J Okla State Med Assoc · Dec 1990
ReviewDiabetic ketoacidosis at the Children's Hospital of Oklahoma: a review on presentation and management.
Examination of 394 cases of diabetic ketoacidosis presenting at the Children's Hospital of Oklahoma from 1975 to 1987 has indicated a higher frequency of very young patients with low insulin requirements and frequent presentation in the winter months. The severity of the preceding hyperglycemia varies widely as indicated by the range of glycosylated hemoglobin values at the time of diagnosis. In addition we have identified measures to prevent the main hazards occurring during therapy which are related to potassium replacement and correction of dehydration without causing cerebral edema. The general principles of management are reviewed and we have selected certain aspects for emphasis and discussion based on past experience.