Chest
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One-hundred thirty mobile intensive care unit paramedics were trained in the technique of direct laryngoscopic endotracheal intubation of cardiac arrest or deeply comatose patients. Three attempts at intubation were permitted. Of the 779 patients studied, 701 (90.0 percent) were successfully intubated: 57.9 percent on the first attempt, 26.1 percent and 5.5 percent on the second and third respectively. ⋯ There were three unrecognized esophageal intubations. The success rate rose to more than 94 percent toward the end of the study. It is concluded that endotracheal intubation of deeply comatose patients is a field procedure safely and skillfully performed by well-trained and monitored paramedical personnel, with success and complication rates at least comparable to other invasive airway techniques.
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A patient with obstructive sleep apnea was monitored five times during three years while his weight fluctuated within a range of 26 kg. The number of apneas per hour of sleep varied from 59.6 at 111 kg of weight to 3.1 at 85 kg. The relation between apneas per hour of sleep and body weight was a logarithmic function. ⋯ Typical SaO2 levels during the apneic episodes also had a logarithmic relation with body weight. Apnea-related sinus bradycardia and sinus tachycardia were only present at the highest weight. The results suggested that dieting and weight loss lead to an improvement in sleep apnea and related sequelae.
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We prospectively studied results of 103 consecutive transthoracic needle biopsies of lung lesions suspicious for malignancy to determine if lesion size, depth within the lung, hyperinflation, second needle passes, or 100 percent oxygen breathing influenced the incidence of pneumothorax. Thirty-eight patients (37 percent) developed pneumothorax. Ten (10 percent) required tube thoracostomy for re-expansion. ⋯ Oxygen breathing did not significantly reduce the incidence of pneumothorax, but may reduce size by increasing the rate of reabsorption. The other factors had little influence. We conclude that the more central location of the lesion and pre-existing lung hyperinflation determine the risk of pneumothorax.
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Some patients with chronic obstructive pulmonary disease (COPD) experience transient arterial hypoxemia (TAH) during rapid eye movement (REM) sleep. To examine the effect of short- and long-term low flow oxygen on TAH associated cardiopulmonary hemodynamics, we recorded pulmonary artery pressure (Ppa) and cardiac output during nocturnal sleep in seven male subjects with COPD. In all of the subjects, parameters were measured breathing room air at baseline time and after eight or more weeks of home supplemental oxygen (15 hours per day, 3 L/min). ⋯ In four of these, total pulmonary resistance was lower and cardiac output higher after home oxygen therapy. Short-term supplemental oxygen is useful in correcting REM-associated TAH and in some hypoxemic subjects, reducing mean sleeping Ppa. Sustained reductions in pulmonary vascular resistance after long-term home oxygen therapy may be indicative of improved cardiac and pulmonary vascular status even in subjects showing minimal or no reduction in mean sleeping Ppa.
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Between 1971 and 1980, some 1,452 patients who had injuries to their chest were hospitalized and treated in our clinic; 949 (65.4 percent) of them had blunt chest injury, and 504 (34.7 percent) had open chest injury. Conservative treatment was given in 1,327 cases. ⋯ A total of 1,272 of the patients who had conservative treatment (95.9 percent) and 118 who had surgery (94 percent) recovered. The overall mortality in patients who had conservative treatment was 4.1 percent (55 cases) and in those who had surgery was 6 percent (seven cases).