Southern medical journal
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Southern medical journal · May 2003
Randomized Controlled Trial Comparative Study Clinical TrialWarmed versus room temperature saline for laceration irrigation: a randomized clinical trial.
Patient comfort is an important part of laceration repair. ⋯ Warmed saline was more comfortable and soothing than room temperature saline as a wound irrigant among patients with linear lacerations.
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Surgical airway intervention is occasionally necessary due to contraindicated or failed endotracheal intubation. In cricothyroidotomy patients, a choice exists between continued long-term ventilation via the cricothyroidotomy portal or conversion to tracheostomy. We examined whether conversion to tracheostomy reduces the risk of acute complications. ⋯ Rate of acute complications with prolonged ventilation via cricothyroidotomy portal is equal to, if not lower than, via converted tracheostomy. Cricothyroidotomy in trauma patients may be used long term without any increase in acute complications.
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Southern medical journal · May 2003
Case ReportsAnesthetic management of a patient with methemoglobinemia.
Methemoglobinemia results from the oxidation of the ferrous iron in hemoglobin to the ferric iron state. Methemoglobin is incapable of carrying O2, and high levels may impact on O2 delivery to the tissues. Methemoglobinemia may result from congenital deficiencies of enzymes that normally convert methemoglobin to hemoglobin, alterations in the hemoglobin molecule itself or, most commonly, from the ingestion of medications or toxins that oxidize the ferrous iron of hemoglobin. ⋯ We describe a patient with acquired methemoglobinemia from dapsone therapy who required anesthetic care for shoulder arthroscopy. The patient's drug-induced methemoglobinemia was diagnosed intraoperatively during previous anesthesia on the basis of discrepancy between the O2 saturation noted by pulse oximetry and that obtained from arterial blood gas analysis. Anesthetic care for patients with methemoglobinemia is discussed and a review of methemoglobinemia presented.
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Southern medical journal · May 2003
Review Case ReportsPersistent left superior vena cava: an intensivist's experience and review of the literature.
Persistent left superior vena cava is a relatively rare vascular anomaly. It is, however, the most common variation in the thoracic venous system. The anomaly is typically detected on chest x-ray after the placement of a pulmonary artery catheter or pacemaker leads. This report describes a case of persistent left superior vena cava detected after successful placement of a pulmonary artery catheter.
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Southern medical journal · May 2003
Case ReportsEsophageal perforation and mediastinitis from fish bone ingestion.
Esophageal perforation is a serious condition with a high mortality rate. Successful therapy depends on the size of the rupture, the time elapsed between rupture and diagnosis, and the underlying health of the patient. Common causes of esophageal perforation include medical instrumentation, foreign-body ingestion, and trauma. ⋯ Esophageal biopsy of a necrotic ulcer revealed foreign material with acute inflammatory changes. Computed tomography scan demonstrated a pneumomediastinum. The patient became hemodynamically unstable and died on the third hospital day.