Chest
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Outcome from cardiopulmonary resuscitation (CPR) at community hospitals is seldom reported in the literature. Data regarding long-term functional status of CPR survivors are virtually nonexistent. We retrospectively reviewed the medical records of all patients receiving CPR during 1989 at a community teaching hospital to determine survival to hospital discharge from CPR. ⋯ We believe survival from CPR at community teaching hospitals is comparable to university hospitals. Additionally, patients who survive in-hospital CPR to hospital discharge have a 54 percent chance of being alive a mean of 31 months postdischarge with most being able to live independently. Further work is needed to validate these long-term functional status results.
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Unilateral pulmonary edema (UPE) is an unusual clinical condition occurring in left heart failure (LHF). Normally, cardiogenic UPE is more pronounced on the right side when no right pulmonary artery obstructive lesion exists. ⋯ Although the precise mechanism of unilateral presentation is not clear, such a left-sided unilateral manifestation is extremely rare in LHF. This is believed to be the first reported case of left-sided UPE with postinfarction VSR.
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Mortality is high in unrecognized pulmonary embolism (PE), but the diagnosis is difficult to establish, especially in patients with coexisting cardiopulmonary disorders. We describe a group of 14 patients with pulmonary thromboemboli in whom transesophageal echocardiography (TEE) performed for coexisting cardiopulmonary conditions established the clinical diagnosis of PE not suspected prior to TEE. The patients had initial clinical diagnoses of heart failure (eight patients), cardiogenic shock (two patients), atrial septal defect (two patients), aortic dissection (one patient), and pneumonia (one patient). ⋯ Ten of the 14 patients were successfully discharged from the hospital. We conclude that occult central pulmonary artery thromboemboli are not uncommon in patients presenting with acute cardiopulmonary disorders and the presence of risk factors for PE and right heart strain on TTE should alert the physician to suspect PE. If and when TEE is performed in patients with acute cardiopulmonary disorders with risk factors for PE and right heart strain, the physician should evaluate the main pulmonary artery and its branches for central pulmonary artery thromboemboli.
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Wide differing criteria are used to define the normal airway response to exercise, and as a consequence the estimated incidence of exercise-induced bronchospasm (EIB) in atopic children is wide. The purpose of this study was to establish normal range for changes in spirometry after exercise in children and then to use these normal values to assess the incidence of EIB in atopic children. ⋯ EIB should be defined by using more than one maximum expiratory flow-volume curve parameter (ie, FEV1 and FEF25-75). The EIB (defined as a fall in FEV1 and FEF25-75) was only seen in asthmatic children and not in other atopic groups.
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We report the case of a woman treated with urokinase for acute pulmonary embolism with a right-sided heart thrombus. She developed life-threatening acute cor pulmonale which dramatically improved within 4 h with recombinant tissue plasminogen activator (rtPA). We emphasize the clinical interest of rtPA for the treatment of life-threatening pulmonary embolism.