Southern medical journal
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Southern medical journal · Oct 1988
Cardiopulmonary effects of the head-down tilt position in elderly postoperative patients: a prospective study.
We studied the use of the head-down tilt position (Trendelenburg) in elderly postoperative patients in the intensive care unit to determine its effect upon cardiac and pulmonary function. Twenty-two patients (mean age 68.4 years) were placed in a 12 degrees head-down tilt position for 15 minutes. ⋯ Because of the uncertain effect of the head-down tilt position upon cerebral blood flow, the routine use of this position is not recommended for the treatment of hypotension or during cardiopulmonary resuscitation. The results of this study, however, show that the cardiopulmonary effects are well tolerated if the position is required, as during central venous access procedures.
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Penetrating trauma to the buttock is an injury with potential impact on multiple body systems. The purpose of this study was to review our experience with penetrating trauma to the buttock, to establish the frequency of system injury and related morbidity and mortality, and to make recommendations for the evaluation and management of these injuries. Among the 56 system injuries, soft tissue injuries predominated. ⋯ There were no deaths in this series. Morbidity consisted of nerve injury/defect in three patients, stroke in one patient, and impotence in one. An understanding of the systems at risk in penetrating buttock trauma is necessary for prompt multisystem work-up.
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Southern medical journal · Oct 1988
Postoperative ketamine analgesia in children: efficacy and safety after halothane anesthesia.
This study was done to investigate the effectiveness and safety of ketamine analgesia after halothane anesthesia for surgery in children. After completion of a surgical procedure, ten children had ketamine (1 mg/kg) injected intravenously during maintenance of anesthesia with 1% halothane in a 60:40 nitrous oxide-oxygen mixture. Cardiovascular parameters measured with noninvasive oscillometry and transthoracic impedance plethysmography remained unchanged after administration of ketamine. ⋯ When ketamine and halothane are administered in combination, careful restriction of dosages of these agents is recommended. Interaction of higher doses of ketamine and halothane has been reported to produce hypotension and bradycardia, which can be avoided with use of subdissociative, analgesic doses of ketamine during light halothane maintenance before emergence. After halothane anesthesia in healthy children, ketamine may be considered a suitable alternative to narcotics for postoperative analgesia.
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Southern medical journal · Oct 1988
Historical ArticleThe physician's obligation to treat AIDS patients.
Medicine's triumph over contagious disease through improved techniques of prevention and treatment in the decades before the appearance of the acquired immunodeficiency syndrome (AIDS) left physicians with little impetus to explore their feelings regarding the acceptance of personal risk in the course of patient care. The rapid expansion of the AIDS epidemic, however, has made it essential for every physician and medical student to confront this issue and determine whether he is willing to accept the minimal risks of transmission posed by the human immunodeficiency virus (HIV) to health care workers. This paper will present five arguments in support of the contention that the physician is obligated to treat all those who would benefit from his care, even when such care entails personal risk to himself. These arguments include the historical traditions of the profession, formal ethical codes, the dependent nature of the patient, the social contract, and medicine as a profession.
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Southern medical journal · Sep 1988
Review Case ReportsStrangulated obturator hernia: can mortality be reduced?
We describe two patients with strangulated obturator hernia to enhance clinical awareness of the varied presentations of this uncommon hernia, which occurs especially in elderly women with either recurrent abdominal pain or partial intestinal obstruction, a positive Howship-Romberg sign, and an absent thigh adductor reflex. Early laparotomy for unexplained bowel obstruction is essential to avoid the complications associated with strangulated obturator hernia.