Klinische Wochenschrift
-
Klinische Wochenschrift · Jan 1991
Case Reports[Diagnosis of suspected acute myocardial infarct in acute regional myocarditis].
We report on 4 patients in whom acute myocardial infarction was suspected due to acute onset of chest pain and elevation of the ST-segment. Furthermore in 2 patients the echocardiography revealed regional abnormal wall motion on admission, the others later. Coronary angiography showed normal coronary arteries in all cases. ⋯ Sometimes regional myocarditis might imitate an acute myocardial infarction. Both, the exact anamnesis and coronary angiography are necessary. The performance of an endomyocardial biopsy is desirable.
-
Klinische Wochenschrift · Jan 1991
Randomized Controlled Trial Clinical Trial[Prevention with pseudomonas immune globulin in burn injury patients with inhalation trauma: does it have an effect on lung function and outcome?].
In an evaluation of the effect of prophylactic application of Pseudomonas immunoglobulin on the immunoglobulin serum concentration, infection rate, lung function and mortality in major burn-trauma patients, a clinical, prospective, controlled and randomized trial along with an extensive literature review was carried out in the intensive care unit (ICU) of a major burn-trauma center at a major municipal hospital in the Federal Republic of Germany. A total of 60 patients suffering from major burn trauma were studied. Some of them exhibited inhalation injury as a secondary trauma. ⋯ The target value of pulmonary function was the O2 quotient (P(ALV)O2-P(ART)O2/P(ALV)O2), which was significantly closer to the normal value in the PIG-SUBGRP. Mortality was lower in the PIG-SUBGRP (34.8%, 8 patients) than in the CON-SUBGRP (50%, 8 subjects). In conclusion, prophylaxis with Pseudomonas immunoglobulin does not appear to be beneficial to burn trauma patients in general; however, it was shown to be effective in burn-trauma patients exhibiting inhalation injury.
-
The type of fluid that should be infused in the critically ill patient remains controversial. In the presence of normal lungs, maintenance of the colloid osmotic pressure (COP) can limit the development of pulmonary edema when the hydrostatic pressure is raised. ⋯ The larger increase obtained in extravascular fluids by the use of crystalloids could limit the availability of cellular oxygen. Nevertheless, differences in morbidity and mortality have not been related to the type of fluid infused, suggesting that the amount of fluid is a more important factor.
-
Klinische Wochenschrift · Jan 1991
Review[Use of hypertonic saline solutions in intensive care and emergency medicine--developments and perspectives].
The primary factor rendering patients at risk of developing multiple system organ failure after shock and trauma is the persistence of impaired microcirculation along with its sequelae for cellular and organ function. Bolus infusion (2-5 min) of 4 ml/kg hypertonic/hyperoncotic saline solution through a peripheral vein is a new concept for primary resuscitation from severe hypovolemia associated with trauma and hemorrhage and is termed "small-volume resuscitation". The experimental data obtained by various research groups have demonstrated the efficacy of 7.2%-7.5% saline solution in restoring central hemodynamics and organ blood flow. ⋯ Of particular importance are the data obtained in experiments on traumatic-hemorrhagic hypovolemia in beagles, which proved that the infusion of 10% dextran 60 in 7.2% saline (hypertonic-hyperoncotic solution) restores nutritional blood flow within less than 5 min, thereby enhancing the circulatory effect of hypertonic saline alone. In the pre-clinical setting, small-volume resuscitation by means of hypertonic saline/dextran solution is aimed at the rapid normalization of the compromised microcirculation and, thus, at the prevention of late complications such as sepsis and multiple system organ failure. The novelty of hypertonic saline/dextran resuscitation lies in its operational mechanism at the microcirculatory level, which also renders this concept attractive for volume support in endotoxemia and septic shock.(ABSTRACT TRUNCATED AT 250 WORDS)
-
The surgeon uses the scalpel rather than the prescription pad, but this fact is deceptive. Analysis of the development of surgical history yields an impressive insight into the interaction between medication and operative treatment. ⋯ With regard to drugs, intensive care medicine confronts the surgeon with an inconceivable complex of interactions, side effects and dose adaptations. In addition, human suggestibility influences the outcome of operative interventions no less than medical drugs.