Southern medical journal
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Southern medical journal · Apr 1993
Comparative StudyExpectations and needs of persons with family members in an intensive care unit as opposed to a general ward.
The positive effect of family support on the outcome from serious illness that requires intensive care has been recognized by clinicians for decades. We have all seen that family visitation and an intensive care environment more similar to that of a general ward (sunlight, radio, television) can benefit patients with psychosis related to intensive care. The severity of illness of the individual patient exerts a powerful stress on the family unit, but it has been difficult to measure this effect. ⋯ The family members of patients in an ICU considered it very important (1) for staff to give directions on what to do at the bedside, (2) to receive more support from their own family unit, (3) to have a place to be alone as a family unit in the hospital, (4) to be informed in advance of any transfer plan, and (5) to have flexibility in the time allowed for visitation. Family members are willing to accept decreased visitation time if the physicians and nurses can equate this decrease with the complexity of care in the ICU. The results of this survey have helped us modify and individualize our approach based on family expectations especially when patients are transferred from the general ward to the ICU or from the ICU to the ward.
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Southern medical journal · Apr 1993
Case ReportsCryptococcal pneumonia occurring as an infiltrative mass simulating carcinoma in an immunocompetent host: plain film, CT, and MRI findings.
Cryptococcosis, a potentially fatal pulmonary infection, rarely occurs in advanced form in immunocompetent individuals. Radiographic findings are variable and include single and multiple mass-like infiltrates, nodules, and segmental infiltrates. MRI manifestations of pulmonary cryptococcosis have not been reported previously. We have compared MRI, CT, and plain film radiographic findings in a case of multisegmental cryptococcal pneumonia occurring as a mass simulating carcinoma in an immunocompetent individual; we have also discussed the differential radiographic evaluation of pulmonary cryptococcosis.
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Southern medical journal · Apr 1993
Pregnant patients in the intensive care unit: a descriptive analysis.
We present a descriptive analysis of experience with pregnant women in the intensive care units at a tertiary hospital. During the period from 1983 through 1990, 38 women were admitted to our intensive care units during their pregnancy or within 2 weeks postpartum. This was a rate of 1 per 400 pregnant patients. ⋯ Follow-up was available for 33 women. The fetal and neonatal loss rate in this group was 4 of 33 pregnancies. In this case series of 38 very ill women, it was apparent that a team approach of obstetricians, anesthesiologists, and intensive care workers provided optimal management for the mother and child.
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Southern medical journal · Mar 1993
Review Case ReportsBeneficial effect of epidural anesthesia on oxygen consumption in a parturient with adult respiratory distress syndrome.
Multifactorial increases in oxygen consumption during labor may exceed available oxygen supply. Cumulative subclinical oxygen debt could be clinically detrimental to both patient and fetus. We have reported the use of continuous mixed venous oxygen saturation monitoring to identify changes in oxygen consumption after painful uterine contractions in a critically ill parturient. ⋯ The absence of venous desaturation with contractions after abatement of labor pains confirmed that pain was the major cause of increased oxygen consumption in this critically ill parturient. Broader use of mixed venous saturation monitoring may allow detection of oxygen deficits during labor and direct appropriate therapy in other critically ill parturients. Similar applications and results have been noted for other disease states in nonpregnant patients.
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Torulopsis glabrata is a yeast ordinarily considered nonpathogenic. Systemic infection with this yeast occurs in patients who are debilitated, immunosuppressed, diabetic, or receiving multiple antibiotics. ⋯ The predisposing condition resulting in debility and predisposition to fungemia was major vascular surgery. Treatment with amphotericin B eradicated the fungemia.