The Surgical clinics of North America
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Surg. Clin. North Am. · Oct 1978
Historical ArticlePerspectives in cardiac surgery with personal reflections.
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Although monitoring of critically ill patients has made giant steps forward in the past 15 years, such monitoring techniques must be viewed as a calculated risk, since a small but finite proportion of patients who are monitored by invasive techniques will suffer untoward and, occasionally, catastrophic consequences. Minimizing the risk involves careful general evaluation of the patient, adherence to strict indications for use of invasive techniques, and care coupled with experience in the actual manipulation. ⋯ The treatment of all critically ill patients must be individualized, and the monitoring techniques employed should be similarly individualized. With such a judicious approach, a great deal of valuable information can be obtained, and an effective and intelligent therapeutic regimen outlines so as to assure a successful outcome in as many patients as possible.
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In patients with nonpenetrating thoracic trauma, the rib fractures and other chest wall lesions may distract the physician from dangerous internal injuries in the chest or abdomen which may not be noted unless looked for very carefully. Early vigorous correction of any ventilatory problem is essential, particularly if there is any evidence of impaired tissue perfusion. ⋯ Rupture of the thoracic aorta should be suspected in rapid deceleration injuries, but is often not considered unless there is widening of the superior mediastinum on hte chest x-ray. Aortography to confirm the aortic tear should be done if time permits, and early repair of the injury provides the best results.