Southern medical journal
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Lactic acidosis, a rare and usually fatal complication of malignancy, is defined as a clinical condition in which the pH is less than or equal to 7.35 and the serum lactate level greater than or equal to 5 mEq/L. We have described the clinical aspects of four cases of lactic acidosis associated with malignancy, and have reviewed all reported cases of lactic acidosis in malignancy meeting the criteria. Rapid recognition of the condition and prompt institution of chemotherapy led to reversal of lactic acidosis in three of our four patients, but long-term survival is related to the responsiveness of the underlying tumor.
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Southern medical journal · Apr 1988
Emergency department infraclavicular subclavian vein catheterization in patients with multiple injuries and burns.
We assessed the complications associated with emergency department placement of subclavian vein catheters in trauma and burn patients, reviewing the charts of all of the 441 patients admitted to the burn-trauma unit through the emergency department during 1983. Fifty-two patients (12%) had infraclavicular placement of subclavian catheters while in the emergency department. Sex, age, insertion site, blood pressure at time of insertion, indications for placement, catheters left in place, and complications were recorded. ⋯ Two upper extremity, 14 gauge percutaneously placed intravenous catheters are usually sufficient for resuscitation; femoral and cutdown routes offer additional sites for massive resuscitation. Subclavian catheterization is seldom needed in the emergency room. Any intravenous lines inserted in the emergency room should be changed within 24 hours to minimize infection.
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Southern medical journal · Apr 1988
Brooks fusion for atlantoaxial instability in rheumatoid arthritis.
Atlantoaxial instability in rheumatoid arthritis has been recognized in the natural history of rheumatoid arthritis, but successful surgical stabilization has proven to be elusive. We review our experience using the Brooks technique of wedge compression arthrodesis combined with halo immobilization in five women with rheumatoid arthritis with symptomatic C1-2 subluxation. ⋯ Follow-up ranges from 18 to 56 months. One major complication occurred in a patient who had significant postoperative quadriparesis in spite of normal intraoperative sensory evoked potentials; it has since slowly resolved.
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Southern medical journal · Apr 1988
Initial resuscitation and assessment of patients with multisystem blunt trauma.
In the vast majority of blunt trauma victims, shock is due to blood loss. Whereas the diagnosis of circulatory collapse is clear-cut, the rapid identification and control of the bleeding source may not be. Such patients often have injuries to several body systems and thus have numerous possible sources of hemorrhage. ⋯ In concert with respiratory management, other members of the trauma team should secure adequate vascular access, resuscitate the patient, and perform a physical examination. Physical findings dictate the order of further diagnostic and therapeutic maneuvers. Patients in unstable condition may need emergency surgery.
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Southern medical journal · Apr 1988
Case ReportsVentricular tachyarrhythmias during cesarean section after ritodrine therapy: interaction with anesthetics.
This case illustrates that patients receiving ritodrine for preterm labor may risk interactions between the residual betamimetic effects of ritodrine and the effects of anesthetics during cesarean section. Such interactions may result in serious cardiovascular complications even after cessation of an infusion of ritodrine. ⋯ Careful fluid administration and cautious use of titrated doses of ephedrine are advised. After delivery of the infant, there should be no contraindication to the use of an alpha-adrenergic vasopressor such as phenylephrine to treat hypotensive patients with tachycardia.