Chest
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A patient with traumatic diaphragmatic hernia had his lesion present remotely after thoracoabdominal trauma as an asymptomatic chest wall mass. This is a rare and, perhaps, unique presentation of this entity.
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Intensive management of patients with severe head injury offers the best hope of minimizing death and functional disability in a young, working population. Secondary neurologic insult can be decreased by cardiorespiratory support and ICP control from the outset. ⋯ Care should not be withheld because of initially grim (and inaccurate) prognostic assessment. Newer techniques for assessing the adequacy of cerebral circulation may allow refinement of management strategies in the future.
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Unplanned removal of an endotracheal airway tube by a patient (SXT) represents a potentially life-threatening incident. Prospective monitoring of all intubated adult ICU patients for one year revealed that 12 of 112 extubated themselves (overall incidence, 11 percent). Comparison of SXT patients with the NXT group disclosed no risk factors for this occurrence. ⋯ The complication (and reintubation) rate in the SXT group was 31 percent. The reintubation rate in deliberate extubations was 11 percent. Self-extubation is a common occurrence which, despite obvious hazards, often is tolerated well by adults.
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Randomized Controlled Trial Clinical Trial
Ultrasound guidance improves the success rate of internal jugular vein cannulation. A prospective, randomized trial.
To compare conventional versus ultrasound-guided internal jugular vein cannulation techniques. ⋯ Intensivists can increase successful internal jugular vein cannulation using ultrasound guidance. Two-dimensional ultrasound should be considered for patients difficult to cannulate or those at high risk of cannulation complications.