Articles: critical-care.
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Thirty-eight emergency cricothyrotomies were performed over a 3-year period. This was the first airway control maneuver attempted in 5 patients, 3 of whom had facial and/or neck injury, one apneic with upper airway hemorrhage, and one with aortobronchial fistula. The remaining 33 procedures were performed only after other airway management failed. ⋯ Twelve of the 38 patients were long-term survivors. There was one long-term complication, a longitudinal fracture of the thyroid cartilage during forceful placement of an oversized tube (8 mm inner diameter) through the cricothyroid membrane. This required operative repair and left the patient with severe dysphonia.
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Anesthesia and analgesia · Jun 1982
Continuous monitoring of mixed venous oxygen saturation in critically ill patients.
A new pulmonary artery balloon flow-directed catheter combines a fiberoptic photometric system for continuous display of mixed venous blood oxygen saturation (SvO2) with the capacity for hemodynamic measurements including thermodilution cardiac output estimation. This oximetry system was studied to determine its accuracy, reliability, and usefulness in the surgical intensive care unit (ICU). ⋯ The catheter values for SvO2 were closely related (r = 0.9516) to those obtained from a laboratory Co-oximeter. Continuous monitoring of SvO2 is accurate and valuable as a warning system for deterioration in cardiopulmonary function and as an indicator of the effects of various therapeutic maneuvers in critically ill patients.
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Anasth Intensivther Notfallmed · Jun 1982
[Tube change in nasotracheally intubated intensive care patients using injector ventilation: a method for the prevention of hypoxic complications].
Conventional methods for the replacement of nasotracheal tubes are often dangerous. The interruption of respiration while replacing the nasotracheal airway may cause severe hypoxia. We developed a technique which shortens the time of apnoe to a few seconds. ⋯ Now the new endotracheal tube is guided into the trachea by the nasogastic tube while jet ventilation is continued. We used this technique 19 times without any complications. We found the method safe and simple, giving sufficient ventilation in all patients, provided that contraindications and precautions are observed.
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The impact on mortality of stabilization in the field before transport of patients with penetrating heart injuries is unknown. This retrospective study compares patients promptly transported with minimal therapy after penetrating cardiac injuries with such patients who had received prolonged attempts at stabilization in the field. During the period of study from 1979 to 1981 23 patients with penetrating wounds of the heart were seen at our institution. ⋯ In this group of patients, a salvage rate of 80% was achieved if transport delays were minimized. In contrast, no patients in whom field resuscitation with concomitant prolonged prehospital delay survived. These data suggest that prompt transport to the hospital without attempts at field resuscitation provides a better chance for survival among patients with penetrating heart wounds.