Lijec̆nic̆ki vjesnik
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Lijec̆nic̆ki vjesnik · Jun 1995
Case Reports[Accidental hypothermia with cardiorespiratory arrest. Case report].
A case of an effective cardiopulmonary resuscitation in a 71-year-old woman following drowning in a cold water and cardiopulmonary arrest for at least 20 minutes is presented. Intubation, ventilation with 100% oxygen, external cardiac massage and administration of adrenaline, 1 mg intravenously, were implemented. Ventricular fibrillation, which occurred after adrenaline therapy, responded to electrical defibrillation with 200 J and converted into a sinus rhythm. ⋯ The patient became gradually conscious, and she was weaned from mechanical respiration after 12 hours. Subsequently, the patient was extubated. There were no neurological deficits.
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An extraordinary advance in basic sciences and technology did not reduce high lethality rate of the septic shock patients. The lethality rate of those patients was and still is around 50%. ⋯ A clinical experiences are disappointing, at first because of our still poor knowledge about various cytokines cascade, feedback mechanisms, cellular protective mechanisms, etc. The new chapter on the treatment of that highly lethal syndrome is open, though a final achievement of that approach is not clear till now.
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A significant improvement has been noticed over the last 20 years in children in whom shock syndrome has developed. This has been attained through the application of technological advances in respiratory, cardiovascular, renal, nutritional support and improved antibacterial and antifungal therapy, but mostly through a better understanding of the physiology of shock. Newer concepts of the pathophysiology of sepsis and septic shock are presented, with clinical definitions referring to the pediatric patient. Innovative therapeutic modalities designed to modulate the systemic inflammatory response triggered by bacterial infection are discussed.
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Lijec̆nic̆ki vjesnik · May 1995
[Complications after prolonged intubation in patients with head trauma].
In this study, 72 patients with head injury, hospitalized in the Intensive Care Unit (ICU) were analyzed. All of them required prolonged intubation. Every patient was initially intubated. ⋯ The patients in the first group developed no complications. Pulmonary infections prevailed in the second group. We conclude that early postinjury tracheotomy is associated with a lesser incidence of complications than prolonged intubation in neurosurgical patients.